Abstract
Stroke is a devastating disease and currently the fourth leading cause of death in
this country. Acute ischemic stroke is an emergency and requires effective triage,
diagnosis, and critical management. The hyperacute management of ischemic stroke begins
in the field, with recognition of stroke symptoms by emergency medical systems (EMS)
personnel. The EMS is an important component to an effective stroke system of care,
which also includes primary stroke centers, routing protocols for acute ischemic stroke,
and telemedicine. Following the arrival of a potential stroke patient to the emergency
room setting, patients should be stabilized and undergo assessment for potential intravenous
alteplase (IV tPA) treatment. Assessments include diagnostic tests, neuroimaging,
and standardized stroke evaluations. After these assessments have been performed,
IV tPA, the only medication for acute stroke approved by the U.S. Food and Drug Administration,
can be considered using a variety of inclusion and exclusion criteria. Previously
time restrictions limited the usage of IV tPA to 3 hours, but this time window has
now been extended for eligible candidates to 4.5 hours. The administration of IV tPA
has specific requirements for monitoring and should be standardized via protocol across
hospitals.
Keywords
acute ischemic stroke - stroke systems of care
